You have been experiencing difficulty sleeping. You may be snoring loudly, or you may be gasping or choking at night. In addition, you may be excessively tired during the day, have morning headaches, and may be depressed or irritable. After consulting with your doctor—and with the help of a sleep lab—you have been diagnosed with obstructive sleep apnea.
If you have sleep apnea, your airway collapses during sleep and prevents air from getting to your lungs. You stop breathing momentarily, which causes sleep disturbance and puts strain on your heart.
Your doctor has prescribed nasal positive airway pressure (PAP) therapy for you. PAP therapy gently blows air into your nose and/or mouth to prevent your airway from collapsing. It is a noninvasive treatment.
PAP therapy will relieve the airway obstruction that occurs while you sleep. PAP treatment can dramatically improve the life of someone diagnosed with sleep apnea. When you wear the system every night during sleep and optimum therapy is achieved, you may experience the following benefits of treatment:
• Increased energy level and attentiveness during the day
• Fewer morning headaches
• Reduced irritability
• Improved memory
• Less waking during the night to go to the bathroom
• Increased ability to exercise
• Increased effectiveness at home or at work
• Improved overall quality of life
You will need to use your treatment every night while you sleep. If you do not, you will return to your previous level of snoring, sleep apnea, and daytime tiredness.
Untreated sleep apnea also has been shown to co-exist with a number of other medical conditions, such as:
High blood pressure
• Heart disease
• Heart attack
• Irregular heart beat
Sleep apnea also may contribute to driving and work-related accidents.
The homecare provider that is providing the PAP therapy equipment to you will assess your healthcare needs, determining and selecting the proper equipment. They will set the equipment at the prescribed pressure setting(s). They will train and educate you and your family on the use, care, operation, and maintenance of the equipment.
|Your device is a||______________________________________________________________|
|Your pressure level is||______________________________________________________________|
|Your mask is a||______________________________________________________________|
“Sleep apnea patients just don’t affect themselves. It affects everybody around them.”
Before you begin treatment, it is a good idea to become familiar with your equipment, which includes a therapy device and mask. Each device and mask comes with specific user instructions. Below is some general information that is common among most therapy devices and masks. Additional information about product features and operation is available from your homecare provider, the product manual, or the resources listed in the back of this booklet.
Continuous Positive Airway Pressure (CPAP) devices deliver a steady, gentle flow of air throughout the night and are a very effective treatment for sleep apnea. Your doctor prescribes one therapy pressure to open your airway, which is what your device is set to deliver throughout the night. Devices are equipped with various features that can help make therapy more comfortable. Ask your homecare provider for more details.
“The next day was the beginning of the rest of my life basically.”
Bi-level therapy devices are set to deliver two levels of pressure during the night – a lower pressure when you breathe out (exhalation) and a higher level of pressure when you breathe in (inhalation). These devices are occassionally prescribed for patients who have trouble tolerating one constant pressure from a CPAP device, this is a decision made by the prescribing physician. Most are equipped with various features that can help make therapy more comfortable.
Auto therapy devices sense your needs and provide variable pressures throughout the night. As with the other models, auto therapy devices are equipped with various features that can help make therapy more comfortable.
“There is a solution to the way you are feeling without medicine, without surgery, without any invasion into your life. It’s going to change your life–and it’s easy to do.”
Humidifiers are designed to moisturize the air that is being delivered to you from the therapy device. There are two types of humidifiers—heated and unheated. Heated humidifiers do not “heat the air,” but will increase the moisture content of the air delivered. Humidifiers can help to reduce some of the side-effects of therapy, such as dry nose. In Canada, Heated Humidifiers are predominately used. For more information on humidifiers, talk to your homecare provider.
The tubing is used to carry the air from the therapy device to the mask. You should clean and inspect your tubing at least once a week to make sure it is clean, pliable, and free of tears. If you think your tubing is ready for replacement, contact your homecare provider.
Therapy devices come with filters. Some units offer you two filters which include a fine filter for improved filtration. Consult your device manual for proper maintenance of your filters.
Masks are used to deliver the air from the therapy device to you. A comfortable mask is a key factor in being able to use your treatment daily. Therefore, finding a mask that fits you and your lifestyle is important. Most masks have built-in exhalation ports that vent your exhaled air. Talk to your homecare provider about the different masks and headgear that are available.
Once you have found a mask that works for you, it is important to maintain it properly. Consult your mask manual for proper maintenance and cleaning instructions. Inspect your mask often for wear and tear. If you think it is ready for replacement, contact your homecare provider. If replacement is needed, most health plans provide coverage for a new mask every six months to a year.
Chinstraps are an optional accessory to most masks. They wrap around the top of your head and underneath your chin to prevent your mouth from opening at night. Chinstraps may be used with a variety of nasal masks if a full face mask (a mask that covers both the nose and mouth) is not being used.
Here is an easy checklist to help you set up your PAP system:
__ Place the machine on a hard level surface close to where you sleep. Plug the machine into a standard, three-prong electrical outlet.
__ Check air inlet filter to ensure it is in place and free of dust.
__ Connect one end of the tubing (hose) to the airflow outlet on the machine and the other end to the mask (or valve).
__ Turn the machine on, place the headgear over your head and the mask on your face. Verify that air is flowing continuously to the mask.
__ If using a humidifier, add distilled water according to the manufacturer’s instructions.
__ If the mask has been properly fitted under CPAP pressure, you may not need to adjust it further. Air should not leak between your face and the mask, however, a small amount of leak that is not bothersome is normal. Your device will compensate for small leaks. There should only be minimal pressure of the mask on the face. Adjusting the mask too tightly is not only uncomfortable, but can cause leaks.
The homecare provider will give you instructions for the safe operation, care, and maintenance of your equipment.
“Who doesn’t want to be a happy family person? Who doesn’t want to be a good employee? I look forward to going to work in the morning. I look forward to getting home – not so that I can get more sleep but I felt like I’d missed out on time with the kids.”
“It’s the best thing that could have happened to me. I’m healthier. I feel better. When I wake up in the morning, you know it’s just great. It’s a feeling I haven’t had in a long time. And I don’t wake up tired. I don’t wake up cranky. And you know, I’m ready to do whatever I need to do for the day.
A good mask fit and seal is critical in long term use and comfort of PAP therapy. Over time the mask becomes worn and may not seal effectively.To get the most benefit from your PAP therapy, your equipment should be replaced when necessary based on wear and tear. For example, your mask may need to be replaced if you notice it is cracked or the seal is leaking. If your tubing is torn, it needs to be replaced. If your equipment is showing signs of wear, you may be entitled to replace your equipment based on the replacement schedule below. Please check with your homecare provider for your individual insurance policy’s replacement schedule.
|EQUIPMENT||HOMECARE PROVIDER RECOMMENDATIONS||MY INSURANCE PLAN|
|Nasal Replacement Cushion|
|Pillows Replacement Cushion|
|Full Face Cushion|
|Filter, Fine Disposable|
|Filter, Gross Particle Foam|
“The mask is like a new pair of shoes...once you break them in, you don’t even know they are there when you put them on.”
• Remove the mask/nasal pillows from the headgear. Clean with warm, soapy water; rinse and let air dry.
• Never use alcohol on the mask or nasal pillows. It can harm the mask.
• Empty the humidifier and let it air dry.
• Change the water in the humidifier.
• Always use distilled water in the humidifier to avoid mineral deposit build-up.
• Clean the humidifier chamber frequently to prevent mold growth. (Straight white vinegar may be used to clean humidifiers of deposits. Be sure to thoroughly rinse with distilled or sterile water prior to the use of the humidifier.)
• Caution: Do not place the humidifier or the mask into the dishwasher for cleaning.
• Clean the grey/black foam filter with warm soapy water. Rinse, allow to dry, then reinstall.
• Wash headgear with warm, soapy water; rinse and let air dry. Headgear is machine washable, but it is best to wash it by hand.
• Wash tubing in warm soapy water, then rinse and air dry.
• Wipe the machine with a soft, damp cloth.
• Replace white disposable filter (if applicable).
Contact your homecare provider if you have any problems that you are unable to correct. Do not attempt to repair your device by yourself.
It is vitally important to find a mask that fits properly and is comfortable to wear. To select the right mask and to maintain its proper condition and fit, work closely with your homecare provider, who will help you through the following steps:
“There is no side effect with positive airway pressure that should prevent you from using it...there is a solution for any problem or excuse you come up with.”
Solutions to common questions and problems
|Question / Problem||Solution|
|When should I start feeling better after beginning to use my CPAP?||Most patients begin feeling better within the first week, though some people may take a little longer.|
|I have a mustache or a beard. Which mask is best to use?||Ask your homecare provider which mask will work best for you.|
|What if I still snore on CPAP?||Snoring while on CPAP should not occur. If it does, contact your doctor. Your pressure level may need to be adjusted.|
|What if I lose or gain weight or my old symptoms reappear?||You may need to have your CPAP pressure level adjusted. Contact your doctor.|
|As I continue to use my CPAP on a regular basis, will my medications need to be adjusted?||Please do not alter your medications without consulting your doctor.|
|If I need to be hospitalized for any reason, should I take my device with me and use it at night?||Yes. Also, if you are having surgery, it is important to tell the surgeon and the anesthetist that you are using CPAP at home. You should also inform the doctor treating you for sleep apnea that you are going into the hospital.|
|I travel frequently. Should I use my CPAP when I travel?||
• It is important that you use your CPAP every night. Purchasing travel accessories will make it more convenient for you to travel with your CPAP.
• Because of increased security measures at airports, it may be easier to travel if you have a copy of your prescription for your CPAP machine with you.
|My skin seems irritated, even bruised, or I have marks on my face.||
• Your mask may be too tight. If your mask has a forehead arm or adjustment feature try readjusting that first. Then, if necessary, readjust the headgear straps.
• You may havethe wrong masksize. Consult your homecare provider for a maskfitting. Nasal pillows or a full face mask may provide a better fit.
|How can I tell when my shows signs of wear and tear.||
• Because masks are disposable, periodic replacement is needed when the mask mask is worn out?
• Inspect your mask for stiffness, cracks, or tears.
|My mask seems to be leaking.||
Follow these steps to fix a leak:
• Check all the connections.
• If your mask has a forehead arm or adjustment feature, try readjusting that first to correct the leak.
• If there is no improvement with the above steps, readjust the headgear straps. The mask should be as loose as possible while still creating a seal. A mask that is too tight against the face can cause leaks to occur by creating folds in the material.
• Try another mask size or type if necessary.
|My mask seems dirty.||
• Wash your mask daily.
• Wash your face nightly before putting on the mask.
• Avoid using skin lotions before putting on your mask.
|It doesn’t seem as though enough air is flowing to me.||
• Check that air from the machine is blowing.
• Check the air inlet and filter for obstruction or dust buildup.
• Check the hose for punctures.
• If you arestill having problems,check with your homecare provideror doctor for assistance
|My nose and throat are dry ,my nose is congested, or I have nosebleeds.||
• Try adding heated humidification. (You will need to ask your doctor for a prescription.) You may change the temperature setting on the humidifier.
• Try nasal saline spray before bedtime and upon awakening.
• This condition may improve over time.
• Consult your doctor if symptoms persist.
|My mouth is dry.||
• You may be sleeping with your mouth open. Try a chin strap.
• If a chin strap is not helpful, a full face mask may be considered or you should consult with your doctor about adding heated humidification.
My eyes are sore, dry, irritated or swollen
• The mask may be leaking into your eyes. Use the forehead adjuster, if applicable. to reduce leaks. Try pulling the mask away from your face and repositioning it.
• The mask may be too tight. Readjust headgear straps.
|My hose fills up with water at night.||• Condensation builds up because the air in the room may be cooler than the air coming from the machine. To prevent this condensation from forming, try placing the tubing under the covers to warm it. You may also ask your homecare provider for a hose cover made of fleece.|
|I have trouble falling asleep on CPAP or I feel uncomfortable when I first apply the air pressure at night.||If the ramp feature is available on your CPAP device, use this feature to slowly rise to your prescribed pressure setting.|
|I feel gassy and bloated when I wake up in the morning.||
• Try sleeping with your head elevated.
• Try using a chin strap to prevent mouth breathing.
• This condition may improve over time.
It is hard to breathe out against the air flow.
• This sensation may improve over time as you adapt to therapy.
• You may benefit from a comfort feature such as pressure relief or an alternate form of therapy, consult with homecare provider.
|My machine does not seem to be working.||
• Check the power cord to be sure it is firmly inserted into the back of the machine be working. and the electrical outlet.
• Contact your homecare provider if you have any problems you are unable to correct.
• Do not attempt to repair the blower unit yourself.
|I just can’t seem to adjust to using CPAP||
• Most people will adjust to CPAP in one or two weeks. Occasionally, it may take a using CPAP. little longer if, for example, you are very sensitive to the feel of the mask on your face or the sound of the device.
• Call your homecare provider or prescribing physician if you are having problems adjusting to the treatment.
• Attending a patient support group if available in your area may provide helpful information to improve your CPAP comfort and use. Additional information also can be found on-line at the Web sites listed on the next page.
“When you are not just wanting sleep all the time, it makes you a better father and makes you a better husband. Makes you a better employee on the job. And, all of a sudden it’s a good cycle that perpetuates itself. And then you realize– I think this is what normal life is supposed to be like and what you’d been missing out on all of that time.”
Most importantly, remember that CPAP is a highly effective treatment for sleep apnea. However, this treatment has no benefit if it is not used. One reason that people may stop using CPAP is that they may experience some of the side effects mentioned in this booklet. Most of these side effects can be easily addressed if a health professional is made aware of questions you may have or if the CPAP user is educated about ways to manage issues that may arise.
Remember that you should not stop using your CPAP without the approval of your doctor. Always consult your doctor if your symptoms do not improve or if your symptoms reappear after treatment has been initiated.
Your homecare provider can give you a copy of Inside OSA, an educational video from Respironics, that will help you understand your treatment. Additional information about sleep apnea, its causes and treatments can be found on several Web sites:
National Sleep Foundation: www.sleepfoundation.org